About Company

Job Description/Responsibilities

Job Summary: As a key member of the Quality and Education team, the Clinical QA Nurse plays a crucial role in ensuring the highest standards of service delivery for our client. Working with care coordinators who use an advanced software platform, you will monitor and evaluate care management services, including Chronic Care Management (CCM), Behavioral Health Integration (BHI), and Remote Patient Monitoring (RPM), provided to eligible patients through partnerships with medical providers. Your primary responsibility will be to oversee the quality of patient interactions, interventions, and care plans, while ensuring compliance with Centers for Medicare and Medicaid Services (CMS) guidelines and other federal regulations. Through audits and constructive feedback, you will guide the team, helping to identify areas for improvement and address quality or compliance issues. Your efforts will help promote a culture of excellence throughout the organization. This position requires a deep understanding of care management practices, proficiency with the client’s software platform, and strong skills in Office applications. Key Responsibilities: • Conduct monthly quality assurance (QA) audits for clinical care team members and enrollment specialists, including: • Reviewing recorded patient calls. • Evaluating the accuracy and completeness of care plans. • Ensuring compliance with regulatory standards. • Assessing the effectiveness of patient communication, with a focus on empathy and compassion. • Document audit findings using standardized QA forms. • Provide both written and verbal feedback to Care Coordinators. • Collaborate with Supervisors and Clinical Managers to address staff performance issues. • Track compliance metrics and create opportunities for improvement, discussing findings with both the team and management. • Regularly inform the Clinical QA Nurse Supervisor of any emerging quality or compliance concerns. • Work closely with the Clinical QA Nurse Supervisor to continually assess and enhance the QA process. • Reinforce new quality and compliance standards with staff as needed. • Attend clinical huddles and POD meetings to ensure clear communication of expectations and serve as a resource for staff. • Support new clinical staff by conducting 2-3 QA reviews per week during their first month and holding in-person meetings. • Stay updated on new quality initiatives and incorporate them into audits. • Efficiently manage and complete assigned tasks. • Contribute positively to the department, supporting all team members in a collaborative and constructive manner. • Adhere to established protocols and best practices. • Perform additional duties as required.

Job Requirements

Qualifications and Experience: • Must be a Registered Nurse or a licensed healthcare professional (e.g., Pharmacy Technician or Physical Therapy Assistant). • Supervisory or training experience is a plus. • Excellent customer service skills, as evidenced by positive feedback from partners and patients. • 1-3 years of clinical experience in care coordination and chronic care management. • Proven ability to adapt to change and meet company standards and expectations. • Ability to provide constructive feedback in a professional and respectful manner. • Strong commitment to achieving company and departmental goals. • Capability to work closely with Care Coordinators, both individually and as a team, to ensure the accuracy and completeness of care plans. • Proficiency with technology, including care management platforms, electronic medical records, email, and Microsoft Office, particularly Excel. • Demonstrated ability to be a positive, supportive member of the department.

Skills

• Accuracy
• Communication
• Customer Service
• Empathy
• Management
• Monitoring
• Quality Assurance
• Software
• Therapy
• Training